The impact of COVID-19 and its response on the psychosocial wellbeing and medical care among persons living with HIV and COPD

Aims: People with COPD and persons with HIV have been recognized as medically and socially vulnerable populations during the COVID-19 pandemic Data on the impact of the pandemic and its response on the psychosocial wellbeing and medical care of persons living with HIV and COPD is lacking We evaluated the mental health and health-care utilization consequences during the pandemic in this population Methods: We surveyed Pittsburgh HIV Lung Cohort participants from May through July 2020 Demographic and clinical data included age, sex, race and smoking history Anxiety, depression and insomnia during the pandemic were evaluated using the General Anxiety Disorder-7 scale, Patient Health Questionnaire- 9 and Insomnia Severity Index The survey assessed for COVID-19 symptoms, health-care access/ utilization and risk/protective behaviours Continuous variables were compared between participants with and without COPD using t-test and Mann-Whitney test as appropriate and categorical variables were compared using Fisher's exact test Multiple and ordinal logistic regression was used to evaluate the association of COPD and any interaction effect by HIV status with anxiety, depression, insomnia, general health status, health-care utilization and risk/protective behaviours All statistical tests were two-sided Results: 136 individuals were included: age 57 9 ±9 5 years;76 5% male;60 3% Caucasian and 39% Black;47% current or former smokers Forty-two (30 9%) respondents screened positive for anxiety disorders, 35 (25 7%) had major depressive disorder and 7 (5 1%) reported insomnia Median scores and proportions across categories by severity of symptoms did not differ by COPD status Of 22 participants with new or worsening symptoms that could be related to COVID-19, only 10 sought medical care Participants with COPD reported similar levels of concern about seeking care due to potential COVID-19 exposures (50 0% versus 42 9%;P=0 64), interruptions in medical care (30 4% versus 27 4%;P=0 801) and a trend to less delay in diagnostic testing as those without COPD (8 7% versus 20 4%;P=0 247) Individuals with COPD were more likely to have sought emergent or urgent care since March (30 4% versus 8 0%;P=0 007) Although all respondents reported practicing social-distancing and masking, the majority (119;87 5%) had in fact continued interacting with people outside the household and 38 (27 9%) joined large gatherings Those with COPD reported similar risk behaviour as those without There was no interaction effect by HIV status See Table 1 Conclusions: Anxiety, depression and concern of COVID-19 exposure were prevalent among persons with and without COPD or HIV Many respondents experienced interruptions in medical care and diagnostic testing and concern about health-care-associated COVID-19 exposure, but this was not more severe inthose with COPD or HIV Despite likely higher risk of poor outcome in those with COPD, individuals with COPD were not more likely to curtail social interactions than those without COPD HIV status also did not seem to modify the impact of COVID-19 on behaviours in this group